CDC: Start Antivirals on Admission for Suspected Flu

Don't wait for confirmatory testing, agency urges.

by John Gever John Gever Managing Editor, MedPage Today
January 09, 2015

Clinicians should give influenza antiviral drugs without delay to hospitalized and high-risk patients with unconfirmed but suspected flu, the CDC said Friday.

"This should be done without waiting for confirmatory influenza testing," the agency emphasized in a Health Alert Network email. Treatment should include one of the three currently approved anti-flu medications: oseltamivir (Tamiflu), zanamivir (Relenza), or the intravenous drug peramivir (Rapivab), the alert indicated.

Also, clinicians were reminded "that influenza should be high on their list of possible diagnoses for ill patients, because influenza activity is elevated nationwide."

The new recommendations appeared to be motivated, at least in part, by recognition that the current outbreak is being dominated by H3N2 viral strains that were not included in this season's trivalent or quadrivalent vaccines for the U.S. and other Northern Hemisphere regions.

For the week ended Jan. 3, according to the CDC's weekly update issued Jan. 9, less than one-third of H3N2 clinical isolates tested matched the A/Texas/50/2012 strain that was included in the approved vaccines. Most common was a strain known as A/Switzerland/9715293/2013, which was included in vaccines designed for the Southern Hemisphere being produced for the season that begins there in several months.

This strain was first detected in the U.S. in March 2014 but was not selected for the Northern Hemisphere products.

None of the viral isolates tested so far has shown resistance to any of the three approved antiviral drugs.

The CDC's surveillance report stated that another five pediatric deaths from flu occurred in the week ended Jan. 3, bringing the season total to 26. Overall flu and pneumonia mortality continued at a rate classed as "epidemic," and the cumulative rate of flu-associated hospitalizations passed 20 per 100,000 population.

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